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D3 Pharm > Anesthesia-Strauss > Flashcards

Anesthesia-Strauss Flashcards

1
Q

methods of administration for inhalationals

A
  • nasal hood for oral procedures
  • full face mask for short procedures outside face
  • LMA (laryngeal mask anesthetic) for longer procedures
  • endotracheal inbubations for longer procedures (goes between vocal cords)
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2
Q

what is MAC?

A

minimum alveolar concentration

-concentration of an anesthetic at which 50% of patients will not respond to a noxious stimulus

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3
Q

How much ‘MAC’ is given for induction vs maintenance?

A

-induction 2-3 MAC and maintenance usually 0.5-1.5 MAC

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4
Q

what are the stages of anesthesia?

A

Guedel’s stages (based on ether)

  • stage I Analgesia
  • II excitement
  • III surgical Anesthesia (surgery here)
  • IV Apnea (can die here)
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5
Q

blood gas solubility

A
  • this coefficient represents the ability of an agent to dissolve in blood
  • only drugs NOT dissolved can see the brain, so the lower the BGS the faster the rise in arterial gas tension
  • also shows speed of recovery
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6
Q

examples of some of the minor inhalational agents

A
  • ethyl chloride
  • chloroform
  • diethyl ether
  • methoxyflurane
  • nitrous oxide (not potent, but hardly minor)
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7
Q

what inhalational agent shows liver toxicity?

A

halothane

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8
Q

which inhalational agent has some seizure activity?

A

enflurane

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9
Q

which agent has the lowest blood gas solubility?

A

Desflurance

-BGS 0.42

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10
Q

pungent odor, so not well tolerated by airway for indution-breath holding, coughing and laryngospasm

A

Desflurane

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11
Q

desflurance

A

-Requires special vaporizer (expensive)
-Lowest B/G solubility of all (0.42) so
very fast in and out
-Pungent odor so not well tolerated by airway for induction-breath holding, coughing and laryngospasm
-High MAC of 6%
-Causes tachycardia so no change in
cardiac output
-Fast shallow breathing with inc PaCO2
-greenhouse gas

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12
Q

Isoflurane

A

-Introduced in 1981
-MAC is 1.2%
-Moderately low BGS so relatively fast in and out
-Pungent ether-like odor so no induction
-Minimal cardiac depression via inc in
HR of 10% (less than Des)
-Good bronchodilator
-Slight metabolism in liver but small (0.17%)
-Good muscle relaxation

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13
Q

which agent is a good bronchodilator

A

isoflurane

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14
Q
  • Newest agent now!
  • Very low BGS (near N2O)
  • Very little irritation so can breathe the patient down
  • MAC 1.71%
  • Great in OMS outpt anesthesia by itself
  • Mild negative inotrope and no tachycardia. CO drops slightly more than others
  • VT drops and rate slightly
  • 5% metabolism but not toxic
  • Must have high flow to prevent Compound A toxicity
A

Sevoflurane

-“the workhorse”

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15
Q

properties of narcotics (IV)

A
  • all are analgesic
  • varying effect on other receptors
  • all are addicting and induce tolerance
  • main effect is reaction to pain
  • lesser effect on perception of pain
  • all are respiratory depressants
  • all cause some nausea
  • all are constipating
  • relief is better with severe, sharp pain rather than constant dull pain
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16
Q

divisions of narcotics

A
  • opiates: morphine, codeine
  • synthetic opiates: dilaudid, heroin
  • opiods (synthetic compounds): fentanyl, demerol, alphaprodine
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17
Q

patient has pin point pupils, what is that called and what are they probably on?

A

-meiosis (opposite would be midriasis), and meiosis is a mallmark of morphine

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18
Q

what narcotic is good for MI patients?

A

morphine

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19
Q

example of synthetic opiod

A

demerol, fentanyl (sublimaze)

20
Q

demerol

A
  • makes the patient have a sympathetic response (I think)
  • shows anticholinergic effects
  • duration 3-4 hr IM, 30-60 min IV
  • good for postop analgesic but fair for sedation, OPD GA
21
Q

synthetic opiod that is used a lot

  • it’s a potent narcotic: 100X morphine
  • fast onset (3 min), short duration (15-30 min IV); good for OPD
A

fentanyl (sublimaze)

22
Q

“stiff chest syndrome”

-what is it, and what causes it?

A

caused when over 100 mcg of fentanyl (sublimaze) is given. It doesn’t happen to everyone, but their chest becomes rigid and you can’t even ventilate them

23
Q
  • sedative-hypnotics
  • relaxation and reduction of anxiety
  • act on limbic system and lesser extent on RAS
  • increase GABA levels locally in these systems
A

Benzodiazepines (given IV)

24
Q

examples of benzodiazaepines and their duration of action

A
  • Long acting (20-80 hours): diazepam (valium)
  • medium acting (10-20 hrs): lorazepam
  • short acting (2-5 hrs): midazolam (versed) and triazolam (halcion)
25
Q

Benzodiazepines

A
  • effect on limbic, RAS (renin-angiotensin system)
  • sedative, hypnotics
  • powerful anxiolytic
  • generally good anticonvulsants
  • all are cardiac and ventilatory depressants
  • good muscle relaxants
  • all lead to dependence, tolerance
  • can see paradoxical (opposite of expected) reactions
26
Q

Valium vs Versed

Diazepam vs Midazolam

A

Versed is about twice as strong (potent) as Valium, but has a smaller therapeutic index so it’s more dangerous
Versed more: potent, anterograde amnesia, resp depression
Valium more: injection pain,/ vein inflammation (thrombo?) and longer duration

27
Q

active metabolites of benzodiazepines

A
  • I think these are specifically referring to valium and versed
  • oxazepam-Serax
  • desmethydiazepam
  • apha 1-hydroxymidazolam
28
Q

what is the principal mechanism of barbiturates?

A

re-distribution

29
Q

three categories of barbiturates

A
  • ultra-short acting (thio, metho)
  • short acting (nembutal, seconal)
  • long acting (amytal, phenobarbital)
30
Q

what drugs discussed are metabolized by the liver and to what extent?

A

-Barbiturates: 20%/hr

31
Q

which drug is an anti-analgesic at low doses?

A

barbiturates

-they actually make the pain worse at low dose

32
Q

patient has Acute intermittent porphyria…

A

don’t give them barbiturates

33
Q

contraindications for barbiturates

A
  • allergic

- acute intermittent porphyria

34
Q

site of action of barbiturates

A

Reticular activating system (RAS)

35
Q

thiopental (Pentothal)

A
  • a barbiturate
  • main use is as induction agent in GA (3-4 mg/kg)
  • may see severe histamine release
  • sedation dose: 20-50 mg total
36
Q

truth serum

A

thiopental in sedation dose (20-50 mg)

37
Q

examples of barbiturates

A
  • thiopental (Pentothal)

- methohexital (Brevital)

38
Q
  • most common agent on OMFS due to short onset and quick duration of action
  • 3X more potent than pentothal (thiopental)
  • induction dose=1 mg/kg
  • may cause shakes
  • intermittent injection technique
A

methohexital (Brevital)

-Brevital shakes

39
Q

Brevital respiratory and cardiac effects

A 
Respiratory
-dose-dependant depression
-hiccups common
-can obtund laryngeal/pharyngeal reflexes
-increased rate-decreased tidal vol
Cardiac
-increased HR
-decreased PVR and BP
40
Q

similar to brevital, but non-barbiturate inducing agent

  • white milky, viscous material
  • injection burns-lidocaine
A

Propofol (Diprivan)

-used instead of barbiturates

41
Q

induction agent

  • phencyclidine derivative (non-narcotic, non-barb, rapid acting)
  • profound analgesia
  • patient doesn’t appear asleep
  • DVS-inc HR and BP
A

Ketamine

-“special K”

42
Q

when is ketamine contra indicated?

A

epilepsy or hypertension

43
Q

what drugs are the anticholinergics?

A
  • Atropine

- Robinul (glycopyrrolate)

44
Q

vagolytic effect on heart rate and secretions

-used in OMFS for secretions and in kids for HR

A

atropine

45
Q

-drying/HR ratio increased

A

Robinul (glycopyrrolate)

D3 Pharm (3 decks)

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